MEDICARE: NISHITA JAIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	A161321	CA
3	207R00000X	Internal Medicine Physician	111751	GA

General Provider Information

NPI Number	:	1952838930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISHITA JAIN

Provider Business Mailing Address
First Line	:	PO BOX 512717
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90051-0717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 BEVERLY BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1804
Country	:	US
Telephone Number	:	310-423-5581
Fax Number	:	310-423-0052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	05/07/2026

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Directions to “ NISHITA JAIN ” Practice Location

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